SCHEDULE 4
(INITIAL CONNECTED PERSONS ASSESSMENT)
The following documentation contains:
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Schedule 4 Form (Initial Assessment Form for Connected Persons) – Child’s Social
worker to complete
Appendix A: Immediate Placement agreement
Appendix B: Authorisation for Temporary approval
Appendix C: Continued Authorisation approval
The child’s Social worker will also need to complete Appendix A. The signature’s of the team
Manager and Service Manager are also required. Appendix B & C are for the Fostering and
Adoption Service to complete.
Process

Where looked after status has been agreed by the Service Manager responsible for the
child, and a family or friend or other person connected with the child is available to care for
the child, arrangements to assess the carer, (immediate requirements under regulation 24)
can be agreed by the Team Manager responsible for the child.

The child’s social worker must immediately contact the Fostering & Adoption Service on 0115
876 2696 to inform the Duty Worker of the placement and/ or request a joint visit. Following
further investigations the child’s Social worker will then need to complete the Schedule 4
Form and forward it to [email protected]
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The Immediate Placement Agreement (Appendix A) must be signed by the carers and
Child’s SW when the child is placed.
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If the placement is agreed as being viable, the Fostering & Adoption Service Manager
completes the Authorisation for Temporary Approval (Appendix B). This should be no
later than 48hrs following the placement of the child.

Once temporary approval for up to 16 weeks has been authorised the Connected Persons
Practitioner will allocate for a full fostering assessment to be completed and book a
Fostering Panel date. Child’s SW to inform IRO, initiate payments via Bacs form, update
Care Plan / Pathway Plan, supply E01 to carer and book 72 hr meeting. F& A Team to
allocate an assessor and initiate DBS checks, Adult Health reports and references.

If the assessment fails to meet the deadline for approval at foster panel within 16 weeks of
placement or the decision is deferred pending further work then an Authorisation for
Continued Approval (Appendix C) can be forwarded by the assessor to the Nominated
Person – Currently the Head of Service for Children in Care for a decision. An extension
period of up to 8 weeks can be granted in order for the assessment to be finished and
presented to a following panel.

Authorisation for Continued Approval (Appendix C) is only intended to be used in
exceptional circumstances. Refusal of extension will lead to the child being removed
from the placement immediately.
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 1 of 1
Initial Assessment for Temporary Approval as a Foster Carer
Connected Person: Regulation 4/ Schedule 4 Care Planning, Placement & Care Review
Regulations, 2010
Child / Young Person’s Name:
Date of Birth:
Current Address:
Prospective Carer:
Date of Birth:
Prospective Carer’s Current Address:
Prospective Carer:
Date of Birth:
Carer’s Current Address:
Relationship between Child and Carer:
Child’s Legal Status and Date:
Date Child Moved to Prospective Carers
(if appropriate):
Social Worker:
Phone Number:
E-mail:
Social Work Team:
Social Work Team Manager:
Phone:
E-mail:
Service Manager:
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 2 of 1
Section 1: Details of Child / Young Person and their Birth Family
1.1 Family details
Child 1
Child 2
Mother
Forename(s):
Surname:
Address:
Date of Birth:
Child /Young
Person’s legal
status:
Parental
Responsibility:
Name of any
other person
with PR:
Ethnicity:
Religion (and
whether
practicing):
Language:
Nationality:
Immigration
Status (if
applicable):
School:
Year:
Statemented?:
Occupation:
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Father
Sibling
(if placed
elsewhere)
1.2
Background History on the Child / Young Person
Brief Background History

Why child is currently unable to live with a birth parent

What are the identified risks?
1.3 Connection / Relationship Between Child/ren and Carers
Details of Relationship Between Child/ren and Carers
How Well do Carers Know the Child? Have they Previously Cared for this Child?
Child’s Wishes and Feelings on Proposed Plan
Section 2: Details of Applicants
2.1 Details of Applicant(s)
Address:
Telephone Number:
1st Applicant
Name:
Previous Name:
Male/Female:
Date of Birth:
Place of Birth:
Nationality and Immigration
Status:
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2nd Applicant
Ethnicity:
Language/s spoken at home
Religion (and whether
practicing)
Local Authority in which the
applicant lives
National Insurance Number
Occupation
Current weekly hours of
work.
Proposed hours of work
following placement
2.2 Details of Children in the Household
Name:
Gender:
Date of Birth / Age:
Ethnicity:
Type of School:
Name:
Gender:
Date of Birth and age:
Ethnicity:
Type of School:
Name:
Gender:
Date of Birth/age:
Ethnicity:
Type of School:
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2.3 Details of other Adult Members of the Household (including grown-up children living
at home)
Name:
Gender:
Date of Birth / Age:
Ethnic Descent:
Relationship:
Name:
Gender:
Date of Birth / Age:
Ethnic Descent:
Relationship:
2.4 Details of other significant adults (i.e. who will be involved/have contact with the
children on a regular basis. Including other extended family members)
Details
Details
Details
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Section 3: Checks and References
Local police check / DBS (CRBs) to be undertaken on everyone in the household aged 16
yrs or over.
Local authority/ Liquid Logic checks to be undertaken on all members of the household
including any children.
1st Applicant
Date & Outcome Of Local
Police Check:
Date & Outcome of Local
Authority /Liquid Logic
Check:
Outcome & Dates of Checks
on All Other Household
Members:
Details of Any Cautions,
Criminal Convictions (Spent
or Current ) or Pending
Investigations/ Charges in
Relation to any Household
Member:
Details of Any Previous
Involvement with Social
Services of any Household
Member.
Including Having A Child
Removed Under Any
Legislation Or Court Order,
Or Subject Of A Care Or
Supervision Order, Or
Subject To A Child
Protection Plan
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 7 of 1
2nd Applicant
Section 4: Accommodation
4.1 Details of Accommodation, Neighbourhood, Community
Description of
accommodation:
Size, ownership and security
of tenure.
The ethnic composition of
the locality.
Proximity and availability of
specific amenities, including
schools, medical resources,
community and religious
groups, and recreational
facilities.
Car available to carers or
proximity to public transport
facilities.
4.2 Home Safety
Basic Health and Safety
check and date undertaken.
Comment on hygiene of
communal areas such as
kitchen, bathroom
Are they appropriate for the
age and abilities of this
child/ren?
Comment on any
issues/support arising.
4.3 Sleeping arrangements for the child
Comment on date seen and
suitability of arrangements
for this child/ren – bed/cot,
bedding, furniture etc.
Is the child sharing a room?
If so who with, are there any
associated risks?
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4.4 Details of pets
Comment on all pets –
Name, breed, age, health.
Any identified risks/ action
to mitigate risks
Section 5 – Finance.
5.1 Financial assessment Household Income and Employment
1st Applicant
Details of working patterns –
current and proposed
Availability to care for
child/ren,
What changes to
employment or additional
support needed to care for
the child/ren and associated
cost implications?
Applicant’s financial
circumstances.Sufficient income to meet
child’s needs, financial
impact of child joining the
family
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 9 of 1
2nd Applicant
Section 6: Health
1st Applicant
6.1 Name, address and
telephone number of family
doctor(s)
6.2 Carers self report on their
physical and mental health
and how this impacts on their
ability to care for the
child/ren.
Including any significant past
/previous health conditions.
Any current or past issues of
domestic violence or
substance misuse
6.3 Does anyone in the
household smoke?
Awareness of associated
health risks for child/ren
placed.
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 10 of 1
2nd Applicant
Section 7: Parenting Capacity – to meet the needs of the specific child/ren
7.1 Ensuring safety
Describe the carers
capacity to protect the
child/ren from harm and
danger
Including any person
who presents a risk to
them.
7.2 Education
Ability to meet the
child/ren’s educational
needs and promote
learning and
development.
7.3 Leisure
Ability to Provide a
stimulating environment
include appropriate
leisure opportunities
7.4 Emotional and
behavioral development
Ability to offer emotional
warmth.
Provide boundaries
without the use of
physical chastisement.
7.5 Health
Ability to meet health
and dental needs.
Child’s current needs
and what is required to
meet these.
7.6 Valuing diversityIncluding child’s identity,
heritage, cultural
background, sexuality,
religion.
Section 8: Family relationships / dynamics and contact
8.1 Birth parents views
of the placement and
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their wishes for the
child
8.2 Relationship with
Birth parents
8.3 Contact
Details of arrangements
Detail any risks.
What support is needed
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Section 9: Recommendations and analysis of placement
Outline current
Care Plan
Recommendati
ons for
placement
Analyse how
this placement
will meet the
needs
appropriate for
the age and
abilities of this
child/ren at
this time
Identify any
potential areas
of concern.
Identify any
issues
requiring
additional
support, a risk
assessment
etc.
Proposed
length of
placement
Nottingham City Schedule 4 (Initial Connected Persons Assessment)Page 13 of 1
Section 10: Signatures
Applicant 1
Name
Signature
Date:
Applicant 2
Name
Signature
Date:
Social Worker
Name
Signature
Date:
Team Manager
Name
Signature
Date:
Service Manager
Name
Signature
Date:
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